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General NPI Number Information
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NPI Number | 1821442252
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Entity Type | Organization
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Legal Business Name | RIVER COUNTRY EYE CARE, PLLC
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 1107 W BROADWAY ST SUITE A
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City | THREE RIVERS
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State | MI
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Zip | 49093-8376
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Country | US
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Telephone | 269-244-3350
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Fax | 269-244-3351
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Provider Business Mailing Address
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Address Line | 1107 W BROADWAY ST SUITE A
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City | THREE RIVERS
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State | MI
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Zip | 49093-8376
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Country | US
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Telephone | 269-244-3350
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Fax | 269-244-3351
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Authorized Official
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Title or Position | OPTOMETRIST/AUTHORIZED MEMBER
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Name | DR. ADAM GOFF
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Credential | OD, FAAO
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Telephone | 269-244-3350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004627
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License Number State | MI
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